Improving the health of the unemployed: a job for health authorities and health workers

Is unemployment pathogenic? A review of current concepts with lessons for policy planners

This review of current literature on the relationship between unemployment and health covers time-series studies and critiques of this approach; micro-level studies of plant closures, which have yet to provide convincing data; and various studies dealing with mortality rates, physical health, mental health, women, children and families, and youth. At particular risk are youth, the economically marginal, and middle-age men. The most common disorders documented are emotional and cardiopulmonary disease. The key to the relationship between ill-health and unemployment may lie in the emerging epidemiological literature relating health status to social hierarchy. The article concludes with suggestions as to how current knowledge on the pathogenicity of unemployment may be of use to health policy planners on issues such as guaranteed annual incomes.

[The health of industrial employees four years after compulsory redundancy]

A controlled, longitudinal study of the health of workers made redundant when a meat products factory closed has been performed using morbidity data extracted from the records of a group general practice. Increases in consultation rates and the number of visits to hospital outpatient departments in the group made redundant are contrasted with opposite trends in a control group who remained securely employed. As in earlier findings, the increases in morbidity in the study group began when they learned that their jobs were in jeopardy.The subsequent employment history of those made redundant was obtained by questionnaire. In the four years after redundancy, 50 of the 76 men in-the study group found new full-time jobs. The other 26 men remained out of work for most of this time or were made redundant once again. This 'jobless' group consulted their general practitioners 57% more often about 13% more illnesses, were referred to hospital outpatient departments 63% more often and visited hospital 208% more frequently than when enjoying secure employment. During an intervening two-year period of job insecurity, there were increases of 45%, 9%, 25% and 28% respectively, for this jobless group.The implications of these findings for primary care, for the National Health Service and for future research are discussed in the present context of high levels of unemployment.

What are health authorities doing about the health problems caused by unemployment?

Unemployment is over three million in Britain, and unemployment is known to be associated with poor health. It has been suggested that health authorities should produce a comprehensive response to the health problems caused by unemployment, and a survey was undertaken to find how many had done so. All the regional and district health authorities in England, the health boards of Wales, Scotland, and Northern Ireland, and the family practitioner committees of England and Wales were asked by letter what they were doing to respond to the health problems of unemployment. A list of suggestions of what they might be doing was enclosed. The overall response rate was 77% (255/331), and 50% (127/255) of the respondents were doing something--33.3% (3/9) of the regional health authorities, 64% (101/158) of the district health authorities and health boards, and 26% (23/88) of the family practitioner committees. The paper describes what they were doing. A relation was sought between the level of unemployment in an area and the extent of the response, and a significant association was found. Half of Britain's health authorities are now responding in some way to the health problems associated with unemployment.